Rezum Therapy for Benign Prostatic Hyperplasia: Dubai’s Initial Experience

Abstract

IntroductionSymptomatic benign prostatic hyperplasia (BPH) is a condition that affects middle-aged men, leading to a decreased quality of life secondary to symptoms of difficult urination, urinary frequency, urgency and nocturia. The treatment modalities of this pathology include pharmacologic and invasive interventions, both of which vary in effectiveness and they come with a myriad of side effects. Recent advancements have allowed for the development of Rezum, a minimally invasive and effective approach to treating BPH while maintaining a good safety profile with comparable outcomes to other treatment modalities. MethodsWe retrospectively identified 49 patients with symptomatic BPH who underwent Rezum therapy in one center in Dubai, the United Arab Emirates between January and December 2020. We assessed several parameters related to their condition including prostate volume, pre-operative and post-operative post-void residual (PVR) and peak urinary flow (Qmax) number of treatments given, trial without catheter and mean date of follow-up. Safety and side effects were also assessed. ResultOur sample included symptomatic men with a mean age of 64 (10) who had a mean follow-up time of three months (IQR 2-5.2), median prostatic volume of 58 cc (IQR 44-82) and a mean of (SD 33.9). The initial Qmax and PVR were 7.3 ml/s (IQR 5.5-10.3) and 80.4 cm 3 (IQR 43.4-120.0) respectively, and post-operative Qmax and PVR were 16.3 ml/s (SD 5.7) and 20.7 cm 3 (IQR 16.2-28.2). Post-operatively, we observed a significant increase in Qmax of 8.11 ml/s (p=0.001) post-operatively, a mean decrease of 94.32 cm 3 (p=0.001) in PVR. The favorable outcome parameters in Qmax and PVR demonstrate the efficacy of this procedure. We have also noted that the change in Qmax and PVR does not vary by initial prostate volume. ConclusionIn this report, we aimed to highlight the benefit, efficacy and safety of offering Rezum to patients with symptomatic BPH in a single center in Dubai, reporting on the first United Arab Emirates experience with this novel procedure. This procedure confers the benefit of being minimally invasive, safe and effective, and with lower rates of sexual dysfunction compared to medical therapy or trans-urethral resection of the prostate (TURP). It is associated with similar outcomes to TURP, and an improvement in quality of life, while carrying a low-risk profile. Our experience corresponds with the available literature regarding the efficacy and satisfaction rates of Rezum for BPH patients. We hope that results from this study encourage further investigation into the long-term implications of Rezum, up to five years post-operatively.

Transurethral water vapour thermal therapy for benign prostatic hyperplasia under local anaesthesia alone: initial experience in Chinese patients

“…The median successful TWOC time was 7 days postoperatively. However, compared with data from other studies (4.1 to 5 days), 11,12 our centre had a longer duration of catheterisation, which could be explained by our centre's policy of scheduling a TWOC on postoperative days 7 and 14 for patients without and with a urethral catheter before surgery, respectively. Five patients were readmitted within 30 days after surgery due to haematuria, post-obstructive diuresis, recurrent AROU, and urinary tract infection with AROU (Table 2).…”

Minimally invasive connective water vapor energy method for benign prostatic hyperplasia

“…Rowaiee et al 37 reported a significant postoperative increase in Qmax of 8.11 ml/s and a mean decrease of 94.32 cm 3 in prostate volume in their study.…”

“…Ines et al evaluated the data of 179 patients aged 45 years and older, with an IPSS score of ⩾8, prostate volume between 20 and 120 cc, with a follow-up of at least 12 months. 35 Garden et al 36 shared data from 36 patients with prostate volume above 80 g and 168 patients below 80 g, while Rowaiee et al 37 retrospectively analyzed data from 49 patients.…”

Efficacy and safety of Water Vapor Thermal Therapy in the treatment of benign prostate hyperplasia: a systematic review and single-arm Meta-analysis

“…Currently, 30–50% of men over 50 years and 80% of men over 80 years suffer from moderate to severe LUTS due to BPH [ 17 ]. TURP is still considered the gold standard medical treatment but is associated with numerous adverse events [ 18 ]. Some vaporization of the prostate by laser or plasma vaporization has been shown to have no significant differences in treatment outcomes and postoperative complication rates [ 19 ].…”