Introduction and objective
Rezūm is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30mL and ≤80mL, it is unclear how effective Rezūm is for men in acute or chronic urinary retention. Our objective is to determine whether Rezūm vapor ablation is effective in the treatment of acute/chronic catheter-dependent urinary retention.
A retrospective chart review was conducted on 49 consecutive patients who presented for acute/chronic urinary retention and were treated with Rezūm. We evaluated procedural details including type of anesthesia, operating room time, treatment time, number of steam treatments, length of hospital stay and catheter duration. We examined details pre- and post-Rezūm including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Q max), post void residual volume (PVR), PSA, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI).
The median age of treated patients was 73 years with a median prostate volume of 73cc (Interquartile range (IQR) 50, 103). All patients were in urinary retention prior to treatment with a median PVR of 900mL (IQR 566, 1146). Following treatment, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved (p <0.01). Qmax increased from 3mL/s to 6mL/s (p=0.03) and PVR decreased from 900mL to 78mL (p <0.01). Only 17/38 patients taking alpha-blockers required continued alpha blocker therapy and 7/15 patients on 5ARIs required continued 5ARI therapy (p <0.01). Of the 49 patients treated, 10 remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months even after further, more invasive surgical therapies for BPH (p <0.01).
Rezūm is an effective therapy for treating acute/chronic urinary retention in patients with BPH. As a minimally invasive therapy, it can be used in patient who cannot tolerate general anesthesia.
Source of Funding