Introduction: Convective water vapor thermal therapy (CWVTT-Rezum) is a minimally invasive surgical therapy that is being increasingly used for bladder outlet obstruction. Most patients will leave the site of care with a Foley catheter in place for a mean reported duration of 2 days. There is no evidence to guide duration of catheterization. A minority of men will fail their trial without catheter (TWOC). An understanding of the factors that drive a failed TWOC is needed. In this pilot study, we aim to identify risk factors for TWOC failure that may improve provider decisions and patient counseling on post-CWVTT bladder management.
Methods: Patients who underwent CWVTT, from 10/2018 – 11/2020, were retrospectively identified through CPT code. Pertinent patient, operative and outcomes data were extracted. Post-operative catheter duration was not standardized. Urinary retention was defined by an inability to void or rising PVR despite multiple attempts at emptying bladder. Patients with neurogenic bladder, pre-operative catheter-dependent urinary retention, and post-operative UTIs were excluded. Potential risk factors for failed TWOC were assessed through logistic regression. The distribution of the number of acute visits between those who succeeded and failed TWOC was assess through an exact Wilcoxon rank-sum test.
Results: 94 patients qualified for analysis. 69% (65/94) and 92% (87/94) completed pre-operative urodynamic testing and prostate imaging, respectively. Average number of treatments for all patients was 6.32 (SD= 2.39). Overall, 20% (19/94 patients) had a failed TWOC. 58% (11/19) failed their TWOC in a delayed fashion. All patients eventually became catheter independent. In patients who failed, the average number of TWOC attempts required for success was 2.31 (SD = 0.60). The mean pre-operative post-void residual (PVR) for successful and failed TWOC was 91.88 (SD 96.10) and 220.78 (SD 220.95), respectively. Only elevated PVR (per 5mL increase) was predictive of TWOC failure on logistic regression (adjusted OR 1.03, p= 0.02). The distribution of acute visits was higher among those who failed TWOC (M = 1.84, SD = 0.76) than those who succeeded (M = 1.29, SD = 0.70; p < .001).
Conclusions: 1 in 5 patients failed their initial TWOC. Higher pre-operative PVR is associated with an increased risk of failed TWOC following CWVTT.
.jpg)
.jpg)
