Siu Brian W H, Liu Alex Q, Leung Chi Ho, Yuen Steffi K K, Leung David K W, Wong Chris H M, Ko Ivan C H, Ho Jeremy M H, Yuen Ryan W Y, Meng Henry Y H, Chan Yvonne Y Y, Yee Chi Hang, Teoh Jeremy Y C, Ng Chi Fai, Chiu Peter K F, Lun Lo Ka
SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China.
Department of Urology, Medical University of Vienna, Vienna, Austria.
Prostate Cancer Prostatic Dis. 2025 May 16. doi: 10.1038/s41391-025-00979-4.
For transurethral water vapor therapy (Rezūm), the number of water vapor treatment cycles has classically been determined by the prostate length, or the fields of vision (FOV). Apart from treating lower urinary tract symptoms, there is emerging evidence on Rezūm for refractory retention. We aim to investigate the optimal number of treatment cycles for Rezūm in catheter-dependent refractory retention.
From 02/2021 to 09/2023, 168 consecutive catheter-dependent patients undergoing Rezūm at three centres were included in this prospective registry. Treatment Cycles Per Unit Prostate Volume (CPV) was calculated by dividing the number of treatment cycles by the prostate size. After propensity score matching of age and prostate size, 144 patients were analyzed in the CPV ≤ 0.15 and CPV > 0.15 groups in 1:1 ratio. The primary outcome was the International Prostate Symptom Score (IPSS) at 1-year follow-up. Secondary outcomes included catheter removal time, 30-day readmission rates, prostate-specific antigen (PSA) reduction. Logistic regression model and linear mixed model were used.
The CPV > 0.15 group demonstrated significantly better IPSS at 1-year follow-up (adjusted mean difference -2.8 points, p = 0.040), and lower 30-day readmission rates (4.2% vs 16.7%, OR 0.22, p = 0.029). Greater PSA reduction was observed in the higher CPV group at 3 months (adjusted mean difference of log-transformed PSA: -0.4 ng/ml, p = 0.022). Median catheter removal times were 14 days (interquartile range 9-29 days) and 15 days (interquartile range 12-40 days) for lower and higher CPV groups respectively (p = 0.059). Six-week IPSS and IPSS-QoL (quality of life score) were similar (p = 0.359 and p = 0.464 respectively).
Higher CPV (>0.15) in Rezūm demonstrated superior 1-year IPSS, lower 30-day readmission rates in our matched cohort. A more aggressive treatment approach, contrasting to the standard FOV-based approach, may benefit catheter-dependent patients.
对于经尿道水蒸气治疗（Rezūm），水蒸气治疗周期的数量传统上由前列腺长度或视野（FOV）决定。除了治疗下尿路症状外，越来越多的证据表明Rezūm可用于治疗难治性尿潴留。我们旨在研究Rezūm治疗依赖导尿管的难治性尿潴留的最佳治疗周期数。
从2021年2月至2023年9月，三个中心连续168例接受Rezūm治疗的依赖导尿管患者被纳入该前瞻性登记研究。单位前列腺体积治疗周期数（CPV）通过将治疗周期数除以前列腺大小来计算。在对年龄和前列腺大小进行倾向得分匹配后，以1:1的比例对CPV≤0.15和CPV>0.15组的144例患者进行分析。主要结局是1年随访时的国际前列腺症状评分（IPSS）。次要结局包括导尿管拔除时间、30天再入院率、前列腺特异性抗原（PSA）降低情况。使用逻辑回归模型和线性混合模型。
CPV>0.15组在1年随访时的IPSS明显更好（调整后平均差值-2.8分，p = 0.040），30天再入院率更低（4.2%对16.7%，OR 0.22，p = 0.029）。在3个月时，较高CPV组的PSA降低幅度更大（对数转换后的PSA调整后平均差值：-0.4 ng/ml，p = 0.022）。较低和较高CPV组的导尿管拔除中位时间分别为14天（四分位间距9 - 29天）和15天（四分位间距12 - 40天）（p = 0.059）。六周时的IPSS和IPSS生活质量评分（QoL）相似（分别为p = 0.359和p = 0.464）。
在我们匹配的队列中，Rezūm中较高的CPV（>0.15）显示出更好 的1年IPSS和更低的30天再入院率。与基于标准视野的方法相比，更积极的治疗方法可能使依赖导尿管的患者受益。
