1. P8-2
Rezum water vapour thermal therapy for benign prostatic hyperplasia: early results from the United Kingdom
Max Johnston1, Tina Gehring1, James Montgomery1, Govindaraj Rajkumar1, Amr Emara1, Tim Nedas1, Hashim Ahmed2 and Richard Hindley1
1Hampshire Hospitals NHS Foundation Trust, United Kingdom
2Imperial College London, United Kingdom
Introduction
The management of symptomatic BPH is evolving and now includes several minimally invasive therapies which aim to improve urinary symptoms whilst maintaining a low likelihood of side-effects. Resection, vapourisation and enucleation of prostate tissue allow for maximum tissue removal with excellent symptomatic benefit, but with a not insignificant risk of sexual dysfunction and incontinence. Furthermore, the side-effects of BPH medication may have been under-estimated and some men would prefer to avoid taking medication.
Rezum is a novel interstitial therapy for BPH which uses convective heating to ablate prostate tissue. The 3-year results from a prospective randomised US trial have demonstrated encouraging and durable results with preservation of sexual function. It is quick and can be performed under local anaesthetic.
This project aimed to report on the results of the first case series of Rezum water vapour therapy in the UK.
Results
Pre-treatment month post
DEMOGRAPHICS AND PATIENT CHARACTERISTICS
55 procedures under local anaesthetic with sedation
Mean age=65.5 years
Mean prostate volume=51.5ml (20-110)
5 patients in retention/CISC
Mean operative time=17.5 minutes
Mean number of treatments=5
66% had median lobe treatment
OUTCOMES
No change in erectile function
Moderate symptomatic improvements at 4-6 weeks
Significant (P<0.01) improvements in flow rate, PVR, IPSS, QoL and prostatic volume at 3 and 6 months
36% mean volume reduction at 6 months
80% passed first TWOC
97% catheter free at 3 months
3 overnight stays (2 social)
Length of follow-up
Number of patients
Baseline 79
4-6 weeks 61
3 months 41
6 months 19
12 months 5
Conclusions
Rezum is an exciting new minimally invasive treatment option for men wishing to preserve sexual function
Rezum significantly improves urinary symptoms at 6 months
These UK results are in line with the US experience of over 25,000 cases
This procedure can be reliably performed as a day-case procedure under local anaesthetic with sedation
It is a versatile procedure which is suitable for patients with obstructing median lobes and gland volumes of up to 100 mls
It would also appear to be an option for those men with retention of urine but further studies are required
Further analysis of cost-effectiveness and comparison to other BPH treatments are underway
Rezum should be considered as an alternative to both medication and established day-case treatment options for men with symptomatic BPH
Method
This study was a prospective case series in two institutions in the United Kingdom. 79 men underwent convective radiofrequency thermal therapy to the prostate. Each 9-second treatment was delivered systematically based on both prostatic volume estimation and endoscopic appearances.
Men were diagnosed and selected for treatment using uroflowmetry, IPSS questionnaires, PSA testing and selected patients underwent prostatic volume estimation or urodynamics. Patients with retention and large median lobes were included. Patients were offered general anaesthetic or local anaesthetic with sedation.
Follow-up was carried out at 4-6 weeks, 3 months, 6 months and is planned for 12 and 24 months. At follow-up outcomes recorded were flow rate, post void residual, IPSS and IIEF-5 questionnaires, prostatic volume estimation, use of new or pre-existing medications, success of trial without catheter and post-operative complications. Analysis reports the above outcomes for patients at each stage of follow-up. This is ongoing work so analysis was only conducted for patients with complete data at each stage of follow-up.
Complications
Nature
Clavien-Dindo Grade n
UTI 2 4
Return to theatre for secondary haemorrhage 3b
Return to theatre for TURP 1
References
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McVary KT et al. Urology Jan:111;1-9.
Ulchaker et al. Clinicoecon Outcomes Res. 2018;10:29-43.
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