Babar Mustufa, Labagnara Kevin, Loloi Justin, Tang Kevin, Ines Matthew, Singh Sandeep, Iqbal Nazifa, Ciatto Michael
Albert Einstein College of Medicine, Bronx, New York, USA.
DSS Urology, Queens Village, New York, USA.
J Endourol. 2023 Jan;37(1):67-73. doi: 10.1089/end.2022.0490. Epub 2022 Sep 22.
Postoperative urinary retention is a common complication following surgery for benign prostatic hyperplasia. We aimed to identify risk factors for a failed trial of void (TOV) following treatment with the Rezum system and assess the impact of a failed TOV on short-term outcomes. A single-office retrospective study was conducted on patients treated with Rezum therapy between 2017 and 2019. A urinary catheter was placed in all patients following Rezum therapy. Demographic data and outcome measures, including the International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), postvoid residual (PVR), and adverse events, were analyzed at baseline and 1, 3, and/or 6 months postoperatively. Risk factors were identified through multivariate logistic regression analysis. A total of 289 patients were included. Thirty-five patients (12.1%) failed a TOV, while 254 (87.9%) had an effective TOV. All patients were given a TOV after a median of 5 days (4-5). Those who failed the TOV spent an additional mean of 13.7 ± 13.3 days with a catheter. Patients who failed the TOV were more likely to get a urinary tract infection compared with those who had an effective TOV (20.0% 4.7%, < 0.001). All patients experienced significant improvements in IPSS, QoL, and Qmax at 1, 3, and/or 6 months. On multivariate analysis, a high baseline PVR was the only independent predictor of a failed TOV (odds ratio: 1.01, 95% confidence interval 1.00-1.01). A greater proportion of patients with a baseline PVR >200 mL failed the TOV (40.0%) compared with patients with a baseline PVR <200 mL (10.9%, = 0.008). Approximately one in eight patients failed the TOV following Rezum therapy. Baseline PVR was the only independent risk factor for a failed TOV. Nevertheless, all patients experienced significant relief of urinary symptoms. Patients with high baseline PVR, particularly >200 mL, may require a catheter for an extended duration.
术后尿潴留是良性前列腺增生手术后的常见并发症。我们旨在确定使用Rezum系统治疗后排尿试验（TOV）失败的风险因素，并评估TOV失败对短期结局的影响。对2017年至2019年间接受Rezum治疗的患者进行了单中心回顾性研究。所有患者在Rezum治疗后均留置导尿管。在基线以及术后1、3和/或6个月分析人口统计学数据和结局指标，包括国际前列腺症状评分（IPSS）、生活质量（QoL）、最大尿流率（Qmax）、残余尿量（PVR）和不良事件。通过多因素逻辑回归分析确定风险因素。共纳入289例患者。35例患者（12.1%）TOV失败，而254例（87.9%）TOV有效。所有患者在中位时间5天（4 - 5天）后进行TOV。TOV失败的患者平均多留置导尿管13.7±13.3天。与TOV有效的患者相比，TOV失败的患者更易发生尿路感染（20.0%对4.7%，P<0.001）。所有患者在术后1、3和/或6个月时IPSS、QoL和Qmax均有显著改善。多因素分析显示，高基线PVR是TOV失败的唯一独立预测因素（比值比：1.01，95%置信区间1.00 - 1.01）。与基线PVR<200 mL的患者相比，基线PVR>200 mL的患者中TOV失败的比例更高（40.0%对10.9%，P = 0.008）。Rezum治疗后约八分之一的患者TOV失败。基线PVR是TOV失败的唯一独立风险因素。尽管如此，所有患者的尿路症状均有显著缓解。基线PVR高的患者，尤其是>200 mL的患者，可能需要延长导尿管留置时间。
