Introduction: Water vapor prostate ablative therapy (Rezum) is used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) in men with prostate glands <80 cc. The technology uses thermal energy via water steam applied transurethrally (in 9-second injection treatments up to 15 treatments) to the obstructive prostate tissue, triggering cell necrosis and sloughing of the targeted tissue. The procedure offers a few advantages, including minimal anesthesia, short duration, minimal sexual side effects, and durable clinical improvement. Multiple variables can influence a clinician to perform the procedure in the operating room (OR) versus the office, including the patient’s anatomy, medical history, or history of instrumentation intolerance. In this work, we seek to compare patients’ selection factors and postoperative outcomes of office versus OR Rezum procedures.
Methods: We retrospectively reviewed patients who underwent Rezum procedures at our institution since 2017. Patient factors including age, AUA symptom score (AUASS), flow rate, post-void residual (PVR), gland size, urinalysis, and anticoagulation status were assessed. Postoperative complications, AUASS, flow rate, and PVR were also assessed. All statistical analyses were conducted using Microsoft Excel.
Results: One hundred and eighty patients who underwent Rezum procedures were identified, of whom 55% were treated in the office. Mean preoperative PVR and gland size were significantly larger in the OR group (367 mL vs. 236 mL) (p=0.01) and (69 cc vs. 56 cc) (p=0.03). OR patients were more likely to have a positive preoperative urinalysis (p=0.003) and require a larger number of treatments (8.1 vs. 6.9) (p= 0.02). OR patients were more likely to require catheter irrigation postoperatively (p= 0.03); however, there was no significant difference between the two groups in serious complications, including sepsis and hematuria requiring operative intervention or transfusions. Postoperative mean AUASS was significantly lower in the OR group 7.5 vs. 12.8 (p=0.03); however, both groups experienced significant objective improvements in flow rate and PVR. Anticoagulated patients were not at an increased risk of postoperative complications.
Conclusions: In our experience, Rezum is safe and equally efficacious in both the office and OR settings with comparable postoperative subjective improvement of LUTS and objective improvement of voiding parameters. Patient factors such large gland size, need for a large number of treatments, positive urinalysis, and need for IV antibiotics may influence the clinician to perform the procedure in the OR. However, office procedures were not associated with an increased risk of postoperative complications.
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