Rezum safe minimally invasive treatment for lower urinary tract symptoms due to benign prostatic obstruction

The researchers observed stably improved voiding function and micturition symptoms over time. A median lobe and preoperative catheterization increase the risk of unsuccessful catheter removal.

"Catheter removal was successfully done in 92.4% after a median of 5 days. There was a significant reduction in International Prostate Symptom Score (IPSS) by 60%, QoL (quality of life) scores by 67%, prostate volume (PV) by 47% and post-void residual (PVR) volume by 85%," the authors reported in their research published in World Journal of Urology. Additionally, an improvement in Qmax (maximum urinary flow rate) was seen by 67%.

TURP (transurethral resection of the prostate) is the standard surgical treatment among various procedures for LUTS caused by benign prostatic obstruction. However, due to changes in demography, surgical therapies are facing a rise in comorbidities leading to challenging decision-making. The demand for minimal-invasive treatment (MIT)modalities is increasing.

One of the MIT options is water vapour thermal therapy (Rezum) by transurethral injection of 103 °C water steam into the prostate. It has shown a beneficial safety and efficacy profile for treating LUTS secondary to BPO. Previous studies have either reported on single specific baseline characteristics such as preoperative catheterization or prostate value or focused on relatively homogeneous collectives of patients. However, there has been no thorough investigation into what extent these results can be translated to a real-world cohort.

Against the above background, Kathrin Bausch, University Hospital Basel, Basel, Switzerland, and colleagues assessed the safety, efficacy, and durability outcomes of water vapour thermal therapy with Rezum in a real-world cohort of patients with LUTS due to benign prostate obstruction.

The study included consecutive, unselected patients undergoing Rezum treatment between 2014 and 2022. Pre- and perioperative data were summarized. The primary outcome was surgical efficacy determined by QoL score, IPSS, Qmax, prostate volume and post-void residual volume at baseline, two months, six months, one year, two years, and > 2 years.

The authors reported the following findings:

• The analysis included a total of 211 patients. After a median of 5 days, catheter removal was successful in 92.4% of patients.
• A median lobe and preoperative catheter increased the risk of unsuccessful catheter removal.
• 5.7% of patients were reoperated after a median of 407 days.
• Comparing the baseline to the most extended median follow-up, the postoperative IPSS decreased significantly by 65.7%, Qmax improved by 66.7% (until 3.9 years), and the QoL Score declined by 66.7% (both until a maximum median of 4.5 years).
• Post-void residual volume and PV were reduced by 85.7% (3.7 years) and 47% (4.0 years). Clavien–Dindo complication ≤ II occurred in 11.8%.

"Rezum is a safe minimally invasive treatment option in a real-world patient cohort with a beneficial improvement of voiding function and micturition symptoms during follow-up," the researchers conclude.

Reference:

Bausch, K., Zahiti, L., Schrutt, M. et al. Water vapour thermal therapy of lower urinary tract symptoms due to benign prostatic obstruction: efficacy and safety analysis of a real-world cohort of 211 patients. World J Urol (2023). https://doi.org/10.1007/s00345-023-04395-y