Introduction: This video describes the technique of local anaesthetics delivery in a intraprostatic manner via a transurethral catheter for Rezum water vapor therapy for a patient with urinary retention on indwelling catheter. Methods: The case was a 65 year-old gentleman. He had been on combination therapy of Alfuzosin and Finasteride and later presented with refractory urinary retention. Transrectal ultrasound sizing of the prostate showed a 52cc prostate. Digital rectal examination showed a benign prostate. Fleet enema and a course of oral antibiotics were given. While awake, he was put into lithotomy position. Schelin catheter was inserted. Aside from the balloon and the drainage channel, the catheter had an extra needle injection channel. Balloon was inflated with 10mL water. Transrectal ultrasound was also adopted in this demonstration for illustration purpose but it was not a pre-requisite. The catheter was turned with the injection channel pointing to the 2 o’clock direction. The needle was inserted fully. It was aspirated to ensure no inadvertent puncture of vessel. Transrectal ultrasound confirms the distal end of the needle was within the prostate stroma. Delivery of local anesthesia intraprostatically was visualised and confirmed on transrectal ultrasound. Needle was withdrawn. The catheter was inserted slightly to detwist its shaft to ensure the whole catheter was rotated to the desired angle. It was then subsequent turned to 5 and 11 o’clock and the above procedure was repeated. 10ml of 1% lignocaine with adrenaline was injected to each lobe of prostate. Balloon was deflated and the Schelin catheter was removed. Rezum water vapor therapy was carried out. A total of 9 cycles including 4 cycles to left and right lobe each, and 1 cycle to the median lobe, each lasting 9 seconds, were delivered. Results: No additional analgesics or sedation was given on top of local anaesthetics. After the procedure, the patient was asked to report on the pain score according to the Visual Analogue Scale. Upon catheter injection he reported a score of 1/10, upon local anesthesia administration 3/10 and upon the Rezum procedure 3/10. He was discharged with a drainage catheter in situ. He returned for voiding trial 14 days after the procedure and successfully weaned off catheter. Conclusions: Schelin catheter allow transurethral intraprostatic delivery of local anaesthetics. It is a possible alternative to transperineal block or regional anesthesia for the Rezum water vapor therapy. SOURCE OF Funding: None
