Presentation Authors: Maximilian Johnston, Basingstoke, United Kingdom, Taimur Shah, London, United Kingdom, Amr Emara, Tina Gehring, Thomas Farmer, Tim Nedas, Raj Kumar, Basingstoke, United Kingdom, Ashley Mcfarlane, Mathias Winkler*, Tamer El-Husseiny, Hashim Ahmed, London, United Kingdom, Richard Hindley, Basingstoke, United Kingdom
Introduction: The RezÅ«m System is a minimally invasive thermal therapy for the treatment of symptomatic BPH. It can be safely performed under local anaesthetic and sedation with minimal side effects as a daycase procedure. We evaluated this new transurethral therapy in patients with moderate to severe symptoms.
Methods: This is the first prospective study of Rezum cases performed in the UK with follow-up planned to 12 months. 181 patients were included, of whom 16 had retention of urine. Prostate volumes ranged between 20-121mls, and patients with an obstructing median lobe were included. Pre- and post-procedure assessments included the validated IPSS questionnaire with quality of life (QoL), urinary flow rate (Qmax), prostate volume and trial without catheter success. Complications were classified using the Clavien-Dindo grading system.
Results: 50 of 181 procedures were performed under general or regional anaesthetic with the remainder under local anaesthetic with sedation. A mean of 5.8 steam injections were delivered to the prostate; 123 patients had a median lobe treatment. Mean operative time was 17.5 minutes. Mean IPSS was significantly improved (-14.9 points, p < 0.001) at 3 months as was QoL. QMax improved by 3.8mL/s as early as 4 weeks and 6.5 mL/s at 3 months. These results were maintained at 6 and 12 months. Overall prostate volume was reduced by 35% by 3-6 months post-operatively, p < 0.001. After first trial without catheter, 132 patients were free of an indwelling catheter and 7 patients remained catheter dependent at 3 months. There were 11 early post-procedure events: 8 patients had a urinary tract infection requiring antibiotics (grade 2), one of whom required HDU admission (grade 4a) and 3 patients returned to theatre for either secondary haemorrhage or for resection of infected prostate tissue (grade 3b). There were 2 patients who required further surgery for ongoing LUTS following their review at 6 months.
Conclusions: Results of this UK experience with the RezÅ«m minimally invasive procedure confirms an early response to treatment with significant relief of LUTS and low morbidity. It is applicable to treatment of patients with an enlarged median lobe and can be performed reliably as a day case procedure. Longer term follow-up will include treatment durability, comparison of outcomes to standard BPH treatments and the assessment of cost-effectiveness.