Introduction: Rezum™ transurethral water vapor thermal therapy is an effective minimally invasive surgical therapy to relieve lower urinary tract symptoms (LUTS) in men associated with benign prostatic hyperplasia (BPH). It is currently indicated for men 50 years of age or older with a prostate volume between 30 and 80 grams(g). The purpose of this study is to explore the efficacy and complications of Rezum™ procedure for prostates greater than 80g.
Methods: We performed a retrospective chart review analyzing men with prostates greater than 80g as measured by Magnetic Resonance Imaging, Computed Tomography or Transrectal Ultrasound who underwent a Rezum™ procedure performed at a single institution from December 2015-June 2020. Patients were excluded from review if their prostate was =80g, or if they had prior surgical management of BPH. Analysis included International Prostate Symptom Score (IPSS), and use of alpha-1 blockers or 5-alpha reductase inhibitors (5-ARI). Data was collated in REDCap and analyzed using the McNemar test for paired nominal data.
Results: A total of 348 charts were reviewed with 57 men meeting criteria for this study. They had a mean age (SD) of 70.8 years old (8.86) and 92.98% were Caucasian. Mean prostate size was 107.5g (23.9), ranging from 80.1g to 175.4g. Mean preoperative IPSS was 18.97 (8.42) with a mean postoperative score of 8.62 (7.54) resulting in a significant reduction of 10.79 points (p < 0.0001). Pre-operatively, 44 men were noted to be on alpha-1 blocker therapy, most commonly tamsulosin (n=39). Of those, 22.7% (n=10) of men took a 5-ARI in combination, most commonly finasteride (n=8). Medical therapy was eliminated in 52% of men post-operatively (p < 0.0001). The intraoperative complication rate was low with only one patient developing hematuria managed with continuous bladder irrigation and another requiring cauterization of prostatic bleeding. There were no reported injuries to the urethra, rectum, or bladder.
Conclusions: Rezum™ use in large prostates appears to be safe without significant complications. We saw a significant decrease in IPSS score and utilization of medical therapy post-operatively. Further investigation could help determine how long patients receive relief of symptoms with Rezum™, and which patients are more likely to fail Rezum™ as a primary surgical therapy based on a prostate size greater than 80g.
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