NHS Fife, Kirkcaldy, Scotland, UK.
University of St Andrews, St Andrews, Scotland, UK.
BMC Urol. 2024 Apr 4;24(1):80. doi: 10.1186/s12894-024-01471-2.
Rezūm™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring.
We propose an outpatient daycase method of delivering Rezūm™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra.
Preliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation.
We demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.
Rezūm™ 是一种相对较新的膀胱流出道梗阻（BOO）治疗方法，它利用水蒸气产生的热能使前列腺组织坏死。这种治疗的标准方法是在手术室进行全身或脊髓麻醉下进行，或在局部麻醉下进行镇静，需要对患者进行监测。
我们提出了一种在局部麻醉下不使用镇静剂的门诊日间 Rezūm™ 治疗方法，使用前列腺局部麻醉阻滞和冷局部麻醉凝胶经尿道灌注。
我们最初的 13 名患者的初步结果表明，这种新技术是可行的，视觉模拟评分法（VAS）平均疼痛评分为 2.1 分，13 名患者均成功完成试验，无需留置导尿管（一名患者第二次试验时成功排尿），国际前列腺症状评分（IPSS）从 20.6 分降至 5.4 分，最大流量从 8.8ml/s 增加到 14.4ml/s。并发症轻微（Clavien-Dindo 分级低于 III 级），包括尿路感染、无需住院的少量出血和逆行射精。
我们证明了在不使用镇静剂的情况下，门诊局部麻醉日间服务是可行的。这种方法可以在诊所环境中实施，减少 BOO 手术的等待时间，并增加手术室用于其他全身麻醉泌尿外科手术的可用性。
