Bassily Daniel, Wong Vincent, Phillips John L, Fraiman Mitchell, Bauer Ross, Dixon Christopher M, Wong Nathan C
School of Medicine, New York Medical College, Valhalla, New York, USA.
Department of Urology, Westchester Medical Center, Valhalla, New York, USA.
Prostate. 2021 Oct;81(14):1049-1054. doi: 10.1002/pros.24201. Epub 2021 Jul 20.
Rezūm vapor ablation is a minimally invasive treatment for benign prostatic hyperplasia (BPH) that uses injections of sterile water vapor directly into the prostate for tissue ablation. Although Rezūm is currently indicated for use in men with prostate sizes ≥30 and ≤80 ml, it is unclear how effective Rezūm is for men in urinary retention. We sought to determine whether Rezūm is effective in the treatment of catheter-dependent urinary retention secondary to BPH.
A retrospective chart review was conducted on consecutive patients who presented for urinary retention and subsequently treated with Rezūm. We evaluated procedural details and examined variables pre- and post-Rezūm (at 6 months) including International Prostate Symptom Score (IPSS), IPSS quality of life (IPSS-QOL), maximum flow (Q ), post void residual volume (PVR), prostate specific antigen, rate of retention, and use of alpha blockers and 5-alpha reductase inhibitor (5ARI).
Of the 49 patients included in this study, median age of was 73 years, median prostate volume was 73cc (Interquartile range [IQR]: 50, 103) and a median lobe was present in 80% of patients. All patients were in urinary retention before treatment with a median PVR of 900 ml (IQR: 566, 1146). Following Rezum, IPSS (17 pre-Rezūm, 4 post-Rezūm) and IPSS-QOL (4 pre-Rezūm, 1 post-Rezūm) both improved at 6 months (p < 0.01). Q increased from 3 to 6 ml/s (p = 0.03) and PVR decreased from 900 to 78 ml (p < 0.01). Only 17/38 patients taking alpha-blockers and 7/15 patients on 5ARIs continued therapy at 6 months following Rezūm (p < 0.01). Of the 49 patients treated, 10 (20.4%) remained in catheter dependent urinary retention following the procedure, and 6 remained in retention at 6 months (12.2%) even after further surgical therapies for BPH (p < 0.01).
Rezūm is a safe and effective therapy for treating catheter dependent urinary retention in patients with BPH, including those with median lobes. As a minimally invasive therapy, it is a promising option in patient, particularly those who are not suitable for prolonged anesthesia.
Rezum水蒸气消融术是一种用于治疗良性前列腺增生（BPH）的微创治疗方法，该方法通过将无菌水蒸气直接注入前列腺进行组织消融。虽然Rezum目前适用于前列腺体积≥30且≤80 ml的男性，但对于尿潴留男性患者，Rezum的有效性尚不清楚。我们试图确定Rezum治疗BPH继发的导尿管依赖性尿潴留是否有效。
对连续出现尿潴留并随后接受Rezum治疗的患者进行回顾性病历审查。我们评估了手术细节，并检查了Rezum治疗前后（6个月时）的变量，包括国际前列腺症状评分（IPSS）、IPSS生活质量（IPSS-QOL）、最大尿流率（Q）、残余尿量（PVR）、前列腺特异性抗原、尿潴留发生率以及α受体阻滞剂和5-α还原酶抑制剂（5ARI）的使用情况。
本研究纳入的49例患者中，中位年龄为73岁，中位前列腺体积为73立方厘米（四分位间距[IQR]：50，103），80%的患者存在中叶。所有患者在治疗前均存在尿潴留，中位PVR为900 ml（IQR：566，1146）。Rezum治疗后，6个月时IPSS（Rezum治疗前为17，治疗后为4）和IPSS-QOL（Rezum治疗前为4，治疗后为1）均有所改善（p < 0.01）。Q从3 ml/s增加到6 ml/s（p = 0.03），PVR从900 ml降至78 ml（p < 0.01）。Rezum治疗后6个月，只有17/38服用α受体阻滞剂的患者和7/15服用5ARI的患者继续治疗（p < 0.01）。在接受治疗的49例患者中，10例（20.4%）术后仍为导尿管依赖性尿潴留，6例在6个月时仍存在尿潴留（12.2%），即使在接受了进一步的BPH手术治疗后也是如此（p < 0.01）。
Rezum是治疗BPH患者导尿管依赖性尿潴留的一种安全有效的疗法，包括那些有中叶的患者。作为一种微创治疗方法，它对患者来说是一个有前景的选择，特别是那些不适合长时间麻醉的患者。
