Water vapor thermal therapy to alleviate catheter-dependent urinary retention secondary to benign prostatic hyperplasia

Abstract

Background Water 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 methods We 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. Results Of 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. Conclusions Water vapor thermal therapy may provide an effective and safe alternative to surgical treatment in this group of catheter-dependent patients in complete urinary retention.

Bipolar radiofrequency thermotherapy treatment of the prostate in urinary catheter‐dependent men

“…McVary et al evaluated the efficacy of convective RF water vapor thermal treatment (Rezum), which is one of the minimally invasive methods that have become popular in recent years, and reported that 26 of 37 patients (70.3%) were free of catheter within the first month after the procedure. In addition, no serious side effects were observed in 20 patients who continued their follow‐up for 15.8 months 27 . Similarly, in the current study, it is noteworthy that among the cases in which the procedure failed, age and prostate size were relatively high.…”

The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia

“…Non‐randomised cohort studies confirm the efficacy data of the pivotal randomised trial. A retrospective study of 38 patients with urinary retention due to BPH and failed ‘trial without catheter’ demonstrated that 26/37 patients (70.3%, one patient lost to follow‐up) could void spontaneously again at a median (range) of 26 (4–65) days, and 18/26 patients (69%) could discontinue using BPH drugs [14].…”

“…1, middle section). Initial studies suggest that~60-70% of patients can become catheter free after PAE or Rez um [36,37].…”

Emerging Data on the Safety and Efficacy of Transurethral Water Vapour Therapy for Benign Prostatic Hyperplasia

“…To date there have been 12 studies published on Rezum, which have included 1391 patients (mean age 68.7 years, range: 46-90) (Tables 1 and 2). [9][10][11][12][13][14][15][16][17][18][19][20] Over half of these studies (n=7) have been published in the past 2 years, reflecting the increasing interest and uptake of this novel intervention. There has only been one randomized study and the remainder represent cohort studies (5x retrospective and 6 x prospective).…”